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Transcript: Knee Pain – How to Address Knee Valgus and Varus

If I need to land on two feet, jump on and off two feet, land on something on two feet, but typically, if you’re going to run, if you’re going to change directions and move in three-plane, three-dimensional space, no. Even if I’m boxing, right? Nobody’s ever 50/50. If I move forward, do I have to eliminate 50/50? I can’t go. I can go like this. Or jump over. Right? But it’s never going to be 50/50. It’s literally going to be me. I’m here. Did you guys see? Look. That’s what brought me forward. This. It’s what brought me back. If I throw a right cross, where am I? What way around my weight? My lead foot, right. If I go here, where do I have my weight? My back foot. But if I go 50/50, I can’t do 50/50 if you’re gonna throw a punch, but if I was gonna throw a baseball, if I was gonna throw it as hard as I can, what do pitchers do? They’re here. Here. Right. They exchange, then they throw the ball and they throw it. And they alternate feet.

So unilateral position you guys have to learn how to balance on one leg. I’ll only be able to teach you so much in this course because this shit gets kinda complicated. But I’m going to give you guys something to work from, a foundation that you can work from on this specific course. Okay? So unilateral positioning will be us. Going here. One foot is back, one foot is forward. It’s almost like if you think about ASIS, right? On the front side. That’s gonna create our line. From there you’re gonna create a box in those dimensions. So if I think about how far I’m going to step back, it’s probably, if I’m going to do the most basic unilateral stance, it’s gonna be the length of my ASIS. I step back. That’s my unilateral position. That’s my base point. Can that change when I run faster? Of course it can change. But for right now this is where we’re gonna work from.

What I want you guys to start getting comfortable with is learning to put weight on your front foot. You’re gonna have to slightly shift over. That’s the issue with training unilateral positioning but I want you guys used to balancing on one leg, having maybe about 5% of your pressure onto your back foot and you’re gonna hang out here. Okay? Now I want you to minimize how much you shift your pelvis anteriorly. I want you guys to think about slightly easy [inaudible 00:02:35] as you’re on your front heel. Start noticing in what direction your knee moves. If you go here and you balance on your left leg, what direction do you see your knee go? Look down at your knee.

So if you balance here, what direction do you see your knee going?

Outwards.

You may see it go inwards. Some people may go outward. What is that an indication of? What function are we not using?

[inaudible 00:03:01](Knee Valgus).

So you’re thinking frontal point, right? How will the legs move?

Sagittal point.

They need to move in the sagittal point, right? So this byproduct of knee valgus and verus is a result of what? What are we lacking?

TBA activation.

We’re lacking TBA activation. Kind of. But what if it’s really lacking? We’re looking at the legs, what are we lacking? Hip what?

Extension.

Extension. We are lacking sagittal plane. So you get people that put a band here and say you got a knee out just put a band here, and we’ll pull up that way. What’s the problem with that? Is that promoting more of this? Which is the reason your body has to do this or this? You guys see what I mean by this? Is this a frontal plane issue? If my knee goes in like this or goes out? Is that frontal plane? It’s a rotational issue happening at the upper body, right? But if you look at it in your lower body, what’s the lacking happening here? Extension. The first function of the gluteus maximus. You guys see what I’m talking about all that?

So if I am lacking extension, my body is automatically gonna have to go oh, oh, oh, oh, oh, and then people start compensating in the frontal plane motion. Are we understood on that? It’s sort of what that is. So what could we do? What could we do in that circumstance? What could we do in that scenario to promote better extension? What do we have to do bio mechanically? If you’re running, if you’re in a full sprint, what are you doing with the ground? Hey guys, hey guys, this is really important, I want you guys paying attention to this. Okay? If you are doing this, you are performing what action?

Extension.

Might we have to start doing that while your leg is on the ground? So, why not just do it right now. When I’m neutral spining it, I put my weight on my front foot, if I start dragging the floor backward, and I institute ground force, what should I be doing for it to work?

[inaudible 00:05:03](Knee Valgus | Knee Varus).

What do you feel working here?

Posterior chain.

You feel the posterior chain activating. Now, rotate your knee out just a little bit and then do it. Rotate that one, more, more, more, now pull. You feel that glute beginning to burn? Yeah. So what are we promoting? The initiation of hip extension. Bend the knee a little bit, wherever your knee is, if it’s out, maybe rotate it in, then pull. If it’s in, rotate it out, then pull. Rotate that knee out on the right side, drag the floor.

And at that point we find neutral, then we begin to institute our ground force, right? So if I’m here, I don’t need the anterior posture [inaudible 00:06:02] till I find neutral. You guys learned what you were doing before, right? If I say I kind of do want to do an anterior tilt, how much anterior tilt am I’m gonna do? How much? Mathematically, what are measurable amount of movement I want to do anteriorly. One millimeter. Remember when we would do that? And pull your belly button in, take the anterior tilt as you do that, and what would happen? You feel your core burn, right? We’re looking at minuscule adjustments, what we’ve been working on all this week. So you’re here, you slide [inaudible 00:06:29](Knee Valgus | Knee Varus), you pull the bellybutton by neutral, slight anterior tilt, one millimeter as we hold that, then we institute ground force. And you guys will see my hamstrings. If I’m here, look at my right hamstring. Navels in, spine’s neutral, rotate the knee out, you guys see that or no?

Yes.

And I’m just pulling on the ground. It’s like [inaudible 00:06:54](Knee Valgus | Knee Varus) coming forward, and that’s when we’d be coming forward. So now I’m setting up that base. How do we address knee valgus? Or knee varus? The question is, how do we address knee valgus or knee varus if your leg is not moving in extension?

What is that knee?

Valgus? Is when your knees come in like this. Varus is when your knees go out like that, okay? Think about it, if I move like this with my pelvis every time I walk, what happens the first time I push you guys, how’d you go? We saw lateral reflection, right? If I have you take a step, where’s your knee going to fall? In? Pelvis is gonna fall out. If you institute lateral reflection with your spine. Right? So because people compensate in this direction here, what’s eventually going to come? Either a valgus or a verus. One or the other. You can’t have one or the other. And what function is missing, guys?

Extension.

Extension. Keep it simple. If you see the knee going this way or that way, what’s the simple solution here? Understand extension. Understand flexion or extension. If you get that, then you don’t have to worry about, well, do I need to load the gluteus medius? What are you promoting when you load the gluteus medius here, guys? More of the same shit. Isn’t the body already compensating laterally? Is it not already doing this too much? By loading the gluteus medius in the frontal plane are you not creating the same freaking pattern? But you see everybody everywhere still, let’s load the gluteus medius, let’s stabilize with the glute medes, Qls maybe. Right? You see them constantly stabilizing that way, but what’s the problem? You are not propelling yourself this way.

So when I’m on one leg, what am I doing? I’m suspending myself, right? Full extension of the femur and rotation of the trunk, the last [inaudible 00:08:40](Knee Valgus | Knee Varus) along with this extension. So what’s holding me up? Rotation, right? It has to be learned here. One of the biggest and most important parts that you can learn out of your biomechanics is going to be getting on your weak foot, knowing where to rotate, and instituting ground force until you feel the musculature right there in that posterior chain fire. Okay? We’re gonna work on that. So some it’s going to be a little bit of a challenge for many, but if you do not learn this, I assure you, you will probably not change your mechanics. This is the first step in it, there’s many layers to this shit, there’s many layers that you have to do to get a body to understand this, but this is gonna be the ground work of it all. If you understand this, this will give you the capacity to learn everything else after that. Okay?

So let’s start drilling this, we’re gonna work on this ground force, okay?

6 Comments

Im a physical therapist and I facilitate similar movement patterns but I think you may be discounting the importance of the glut med. While the main focus for that varus/valgus moment needs true extension, there are multiple planes involved that need to be stabilized to allow movement — I always say proximal stability for the distal mobility. With out the glut med you’ll have a hip drop on the opposite side during gait which will effect and sometimes produce that medial collapse of the LE causing a valgus moment. Not to mention the power coming from the ER torque in a closed chain position like a SLS or squat.

My thoughts are that if I have a transverse abdominis that should prevent lateral flexion (main cause of hip drop), that the glute med would have much easier time help to stabilize through movement. Is the glute med supposed to do work? Most definitely, but from the reference of seeing that torque through the rotational slings are what suspends a human body through motion, it appears people over-facilitate the that muscle because they simply do not know how to institute the simple biomechanical usage of thoracic/ribcage rotation. Ofcourse things make sense when we look at limited variables and when the extent of our “rehab” only attempts to take you away from pain for a given moment, but when you move into the field of movement and pain/injury prevention, the game gets much more complicated. To keep it simple, you have to integrate more variables. A lot more than what the industry cares to take at this stage in the game.

Steph, Good point. If you are lacking mobility in the sagittal plane, dorsiflexion, it may show up in the transverse or coronal plane. This may assist with excessive hip drop and/or increased valgus stress.